1
Q
What are the 2 primary classification systems to diagnose a mental illness?
A
Diagnostic and Statistical Manual (DSM-5)
&
International Classification of Diseases (ICD-11)
2
Q
5 characteristics of the DSM-5
A
- focuses only on mental disorders
- can be updated quickly
- mainly used in Canada and USA
- mainly used by psychiatrists
- focuses on secondary psychiatric care in high income countries
3
Q
5 characteristics of ICD-11
A
- includes all physical ailments & mortality rates
- cannot be updated quickly because the whole book would need revision
- more attention is given to primary care in low & middle income countries
- created for the use of all healthcare providers
- only has one diagnosis for PD
4
Q
How many Canadians in a given year over the age of 15 are living with a mental illness?
A
1 in 5 (20%)
5
Q
What are the 2 most common mental illnesses and their prevalence rate in Canada?
A
Mood & anxiety disorders account for about 70% of all mental disorders in Canada
6
Q
3 criteria used when determining if an individual has a mental illness
A
- how different is the behavior?
- how disruptive is the behavior?
- to what degree is the person distressed by the behavior?
7
Q
3 criteria that formal patients must meet in order to be admitted (Mental Health Act)
A
- the individual has a mental disorder
- the individual is likely to cause serious harm to themselves
- the individual suffers substantial mental or physical deterioration or serious physical impairment
8
Q
define performance-based assessment
A
allows clinicians to observe how a person functions in their own environment
9
Q
define IADLs and 2 examples
A
instrumental activities of daily living
can a person safely prepare their meals? can they pay bills?
10
Q
define ADLs and 2 examples
A
activities of daily living
brushing one’s teeth, washing one’s face
11
Q
4 factors that can influence assessment
A
- positive & negative biases that healthcare workers may have
- the environment that the assessment occurs in (eg. loud room)
- not considering personal factors (eg. ESL)
- not having appropriate norms to compare the cognitive performance of the person being assessed
12
Q
what is the most common mood disorder?
A
depression (major depressive disorder, MDD)
13
Q
define depression for a formal diagnosis
A
loss of interest in activities that one previously enjoyed and low mood
14
Q
5 symptoms of depression
A
- feelings of worthlessness & hopelessness
- excessive guilt
- lack of motivation
- weight loss
- negative thoughts about oneself, the world, and the future (negative triad)
15
Q
which age groups have the highest and lowest rates for depression?
A
highest: ages 18-34
lowest: ages 65+
16
Q
what are the depression in LTC ranges? (worldwide & in Canada)
A
worldwide: 11% - 85%
Canada” 14% - 44%
17
Q
what is SSD and who is most likely to present it?
A
subsyndromal depressive symptoms are less severe symptoms of depression that interfere with daily functioning
older adults are more likely to present
18
Q
5 risk factors for depression
A
- physical illness
- low social support
- isolation
- poor subjective health, recent bereavement
- change in residence
19
Q
a combination of pahrmacotherapy & psychotherapy can be used for the treatment of what disorder? give 3 examples
A
depression
- SSRIs (selective reuptake inhibitors), SNRIs (serotonin & norepinephrine reuptake inhibitors), and atypical antidepressant (bupropion & mirtazapine)
- ECT (eclectroconvulsive therapy)
- CBT, group therapy, PST (probem-solving therapy), and mindfulness-based cognitive therapy
20
Q
what is the most common mental disorder?
A
anxiety disorders
21
Q
define anxiety disorders
A
symptoms like nervousness, fear, and worry that interfere with an individual’s ability to function
22
Q
10 symptoms of anxiety disorders
A
- fear
- worry
- nervousness
- increased heart rate
- sweating
- dry mouth
- chest pain
- hyperventilation
- diarrhea
- insomnia
23
Q
what is the most common anxiety disorder found in older adults?
A
GAD (generalized anxiety disorder)
24
Q
what are the prevalence rates for GAD and which gender is it higher for?
A
1% - 17%
higher for women
25
what are the treatments for anxiety disorders?
- SSRIs
- CBT, supportive discussion groups, relaxation therapy
26
define late-onset alcohol-use disorder and how many older adults alcoholics fall into this category?
older adults who have been abusing alcohol before 60 y/o
2/3 older adults alcoholics fall into this category
27
psychotic disorders include abnormalities in at least 1 of the 5 domains...
- delusions
- hallucinations
- disorganized thinking (speech)
- abnormal motor behavior (including catatonia)
- negative symptoms
28
what is the difference between a primary psychosis and a secondary psychosis
primary: psychosis caused by a psychiatric illness
secondary: psychosis caused by a medical/neurologic condition
29
___% of psychotic disorders in older adults are due to ___
60% are due to a medical/neurologic condition
30
4 risk factors for psychosis
- poor health status
- cognitive problems
- visual impairment
- negative life events
31
what are the 2 types of symptoms of schizophrenia & 2 examples for each
Negative symptoms: something is taken away from the person (reduced motivation, inability to show emotions)
positive symptoms: something is added to the person (hallucinations, delusions)
32
what is the prevalence of schizophrenia in older adults?
0.1% - 0.5%
33
when are men and women most likely to be diagnosed with schizophrenia?
men: before the age of 40
women: after the age of 60
34
what is the course of schizophrenia? 3 points per period
Symptom onset & early course:
Frequent losses
Unstable financial support
Confused about the symptoms
Middle course: adaptations to symptoms:
Transition period
Symptom improvement
Learn self managing/coping strategies
Present & future outlook:
Despair over lost opportunities
resignation/acceptance of current situation
Hope & optimism
35
define hoarding disorder
Is the persistent difficulty in discarding or parting with possessions, regardless of their actual value
36
when does hoarding disorder begin and when does it get identified/treated
usually begins in childhood or adolescence
usually doesn’t get identified/treated until one’s 50s
37
what are the prevalence rates for hoarding disorder?
2.3%
38
5 characteristics of those with hoarding disorder
- unmarried, live alone
- have a strong affection for objects, emotional sensitivity, and perfectionism
- problems with executive functioning
- can be linked to OCD
- MDD is usually a co-morbidity
39
what is the treatment for hoarding disorder?
CBT
40
define problem-focused coping and who is most likely to use it
involves using coping strategies that attempt to change the problem in some way
Tend to be used more by younger adults
41
define emotion-focused coping and who is most likely to use it
involves coping strategies that deal with the feelings associated with the problem
Tend to be used more by older adults
42
define positive psychology and what i has shown to decrease and improve
Is the scientific study of strengths, well being and functioning
shown to decrease depressive symptoms and pessimism
shown to improve life satisfaction, psychological well-being, resilience, and hope
43
define neurocognitive disorder
having a decline in 1 or more areas of cognitive functioning
44
define mild neurocognitive disorder
modest cognitive decline from a previous level of functioning which does not significantly interfere with daily activities
45
define major neurocognitive disorder
significant decline from a previous level of functioning which interferes significantly with daily activities
46
define fronto-temporal neurocognitive disorder (FTD) and which areas of the brain in affects
a cluster of syndromes that result from degeneration of the frontal & temporal lobes
affects areas of the brain linked to personality & behavior
47
define the behavioral type of FTD
a person’s mental filter is altered so that social rules are no longer considered when talking/behaving
48
define the 2 language types of FTD
non afluent aphasia: difficulty communicating orally and with written words
primary progressive aphasia: language capabilities become slowly and progressively impaired
49
define neurocognitive disorder with lewy bodies
involves progressive cognitive impairment which appears to affect complex attention & executive function rather than learning & memory
50
what can be experienced with neurocognitive disorder with lewy bodies
- hallucinations
- sleep issues
- delusions
- repeated falls
- fluctuations in cognitive abilties
- maybe parkinson-like symptoms
51
define alcohol-related dementia and what is it often caused by
due to excessive & prolonged use of alcohol which leads to damage to the structure & function of the brain
Often caused by thiamine deficiency or a number of underlying factors (neurotoxicity & nutritional deficiencies)
52
define delirium
acute deterioration of mental status in which an individual exhibits deficits in attention, altered levels of consciousness, & psychotic features
symptoms are treatable and tend to go undetected in older adults
53
symptoms of delirium
- develop over time and fluctuate throughout the day
- could resolve after a few days or months
- impairment in vision
- difficulty having simple conversations
54
reversible causes of delirium
- infections
- sensory impairment
- trauma
- surgery
- constipation
- adverse drug effects
55
define mild cognitve disorder MCI
a range of diseases that include impairment in both memory & non-memory cognitive domains & does not interfere with daily life acitivites
56
define the 2 types of MCI
amnestic MCI: where memory loss is the main symptom & is most common subtype of MCI
non-amnestic MCI: memory is not impaired, but other thinking abilities may be affected (planning, judgment, organizing, etc)
57
define vascular dementia
dementia caused by brain damage
58
what is the 2nd leading cause of dementia
vascular dementia
58
what can vascular dementia be caused by
cerebral vascular incident (stroke) --> sudden onset with gradual progression or fluctuating decline
ischemic stroke: sudden brain blood vessel blockage → most common
hemmorrhagic stroke: sudden brain blood vessel rupture
cerebral small vessel disease: which arises from damage to small arteries, arterioles, capillaries, and white matter lesions (small veins in the brain) --> gradual onset with slow progression
59
7 communication difficulties among people with dementia
- Word finding difficulties
- Creating new words for those that are forgotten
- Repeating words or phrases (perseveration)
- Difficulty organizing words into logical sentences
- Cursing or using offensive language
- Reverting back to the language that was first learned
- Talking less than usual
59
5 ways to approach communication with someone with dementia
- Learn about dementia, its progression, and its impacts on all
- Believe that communication is possible at all stages
- Focus on the person’s abilities & skills
- Reassure & be positive
- Meet the person where they are & accept their new reality
60
8 communication strategies with those with dementia
- Always approach from the front
- Position yourself at their eye level
- Wait until the person looks at you before speaking
- Listen to the feelings & needs behind the words
- Talk about one thing at a time
- Avoid saying “you can’t”
- Avoid overwhelming questions
- Be patient & avoid jumping in
61
define alzheimer's disease
progressive decline in all areas of cognitive functioning
62
what is the most common form of dementia
alzheimer's disease
63
define Early-onset familial Alzheimer’s disease
occurs before the age of 65 and individual has a positive family history of Alzheimer;s for at least 3 generations → hereditary
64
a mutation in of 3 of these genes places you at greater risk for alzheimers
PS1, PS2, amyloid precursor protein
65
define Sporadic Alzheimer’s disease (“late onset”)
occurs after age 65 due to a combination of genes, environment, and lifestyle
66
describe the 3 ApoEs (Apolipoprotiens) found most important to the development of alzheimers
- ApoE2 → carrying 1 copy can reduce the risk
- ApoE3 → shows no influence
- ApoE4 →present in about 50% of those with “late onset”
67
5 symptoms of alzheimer's
- impaired memory & learning (reported early)
- Getting lost while driving (reported early)
- Impairments in attention, reasoning, judgment, problem solving, language abilities, and visual perception
- Increasing difficulty with daily tasks
- Inappropriate social behavior & changes in personality
68
describe the 3 stages of alzheimers
mild stage: usually stay independent but may need help with certain activities to stay safe
moderate stage: diffculty communicating & performing daily tasks, behavioral & personality changes, often the longest stage
severe stage: most likely need full-time care, communication is very impaired, aggression & agitation is common, difficulty drinking & eating which can cause infection & death
69
what are some brain changes for alzheiemrs
- atrophy: decrease in size of an organ/tissue
- amyloid plaques: abnormal deposits that form outside the neuron
- Neurofibrillary tangles: tau components that collapse into twisted strands and occur inside the neuron → causes the inability of nutrients to move through the neuron, causing death of the neuron
70
describe the formation of amyloid plaques
Amyloid precursor protein (APP): protein that remains both inside and outside of the neuron, and the part that remains outside gets cut off by secretases (enzymes… see below)
Alpha-secretase: normally, cuts off the APP that remains outside the cell that has the potential to become beta-amyloid
Beta-secretase: in Alzheimer’s, cuts APP off in the wrong place which causes beta-amyloid (sticky substance) to form, which produces plaques that cannot dissolve
71
define tau
a protein that helps maintain the stability of microtubules which keep the parallel strands straight (of the neuronal transit system)
72
3 biomarkers for alzheimers
- Progressive atrophy of the brain → could be seen using CT scans
- Distribution of tangles → could be seen using PET imaging
- Predictions based on biomarkers show that these abnormalities come before the onset of clinical symptoms by at least 2 decades
73
risk factors for alzheimers (decrease and increase)
increases:
--> strong:
- traumatic brain injury
- mid-life obesity
- mid-life hypertension
- smoking
- diabetes
--> possibly linked:
- history of depression
- sleep issues
--> unclear:
- hyperlipidemia
decreases:
--> strong:
- higher education
- physical activity
--> moderately linked:
- mediterranean diet
- cognitive training
--> possibly linked:
- moderate alcohol consumption
--> unclear:
- social engagement
74
define parkinson's
chronic & progressive disorder of the nervous system that affects movement → no known case & no cure
75
symptoms of parkinson's
- Tremors of the hands, arms, legs, jaw, & face
- Slowness of movement
- Rigidity or stiffness of the limbs & trunk
- Impaired balance & coordination
76
how many canadians living with a form of dementia? how many are women?
500,000 canadian
2/3 are women
77
FTD accounts for ___% of all dementias
5-10%
78
what is the FTD survival rate from symptom onset
6-11 years
79
what is the prevalence rate of lewy body dementia
0.1-5%
80
average life expectancy of general alzheimers after diagnosis
about 8 - 10 years
81
how many people in canada have general Alzheimer? over age 65? over age 85?
over 65 = 1 in 20
over 85 = 1 in 4
82
why could mostly women have alzheimers
loss of estrogen during menopause & societal factors
83
prevalence rate for early onset alzheimers
less than 1-5% of all cases
84
what are the sex difference for MCI
more research is needed
85
prevalence rates for vascular dementia
15-20% of all cases
86
how many peopple in canda have parkinsons 18+? 65+?
55,000 aged 18+
79% age 65+
87
3 treatment issues related to neurocognitive disorders
Cognitive enhancers: acetylcholinesterase inhibitors (AChEls) --> no significant effects found
memory training--> gains are made initially but not retained over time
Behavioral & Psychological Symptoms of Dementia (BPSD)
--> Agitation & aggression are most common & distressing examples
Disinhibition, apathy, & psychosis are also examples
88
define informal caregiving
by a family member/friend who provides unpaid care for a loved one who is living with a disability/illness
account fro 80% of care
89
examples of informal caregiving
Providing transport, house work, scheduling appointments, managing finances, personal care, medical treatments, etc
90
define caregiving burden
the negative aspects of caregiving
91
3 types of stigma for those with alzheimers
Self-stigma: internalizing illness stereotypes & formulating prejudice and discrimination against oneself
Structural stigma: the quality of healthcare services & inadequate behavior of professionals
Stigma by association: the emotions & beliefs of those closest to the stigmatized person (family, friends, etc)
92
8 red flags that driving may be unsafe for those with dementia
- Unaware of driving eros
- Getting lost or confused while drivings
- Trouble navigating turns
- Difficulty staying in lane
- Missing traffic signs
- Unable to keep up with traffic speed
- Getting honked at
- Scrapes on the car/garage
93
define traits
an individual’s usual characteristic way of behaving, thinking, and feeling
94
3 ways personality traits are measures
Mean-level change: measured by comparing mean levels of a personality trait (ex. Measuring neuroticism between 2 or more points in time)
Rank-order consistency: measures the stability of an individual’s rank-order within a certain group over time
Intra-individual change: measuring personality change at the individual level
95
define maturity principle
people become more agreeable & emotionally stable, more conscientious, and less neurotic with age
96
big 5 traits & descriptions
Openness to Experience
Original, imaginative, creative, curious, daring, artistic, independent
Conscientiousness
Careful, reliable, hard-working, ambitious, well-organized, energetic, persevering
Extraversion
Sociable, fun-loving, affectionate, friendly, passionate, active
Agreeableness
Good-natured, soft-hearted, courteous, selfless, easy going, forgiving
Neuroticism
Fearful, angry, anxious, insecure, moody, jealous, self-conscious
97
which traits have the widest gap between women and men for those in the middle age category (70-79)
Openness and neuroticism:
98
describe the agreeableness trend among women and men
women score higher than men, but the gap begins to close in the middle-age category (70-79) and completely close in the oldest-old (80-92)
Adult Development & Aging
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